- Email: [email protected]
OR Fact and Principle
OR FACT AND PRINCIPLE Frances E. Reeser, R.N.
Q. Who is responsible for establishing safe practices in the operating room? At our hospid, the nurses feel that this responsibility should belong to the OR Supervisor. The Chief of Anesthesiology feels that he should set the policies. A. It is a cooperative effort. The OR Supervisor, with the cooperation of the Anesthesiologist, the Chief of Surgery, the Chief of Engineering and the Administrator, can plan a good safety program for the operating room. A well-trained OR staff can be the best guarantee for a good safety program. This training can be accomplished by demonstrations, lectures, films, and discussions. The OR Supervisor can depend upon the Anesthesiologist for control of anesthetic gases and equipment. She can call upon the engineering department for control of temperature, humidity, electrical systems, and all necessary safety signs. We must also keep in mind that safety measures in the OR are everyone’s responsibility. Q. Our operating room is air-conditioned, so we do not worry too much about the raccumulation of explosive gases. But is there any danger of explosion in an air-conditioned room? A. When we speak of air conditioning an OR,
August 1969
a: we are speaking of many things: 1) Temperature and humidity control. 2) Mechanical ventilation to provide safety and comfort for patients and personnel. 3) Aid in removing odor. 4) Control of air-borne bacteria. The air conditioning reduces the danger of explosion but does not eliminate it. Many factors have to be considered such as: 1) Temperature and humidity. 2) Conductive clothing and footwear. 3) Conductive floors and furniture. 4) Preventive maintenance and handling of electrical equipment. 5 ) Controlled smoking areas. 6) Explosion-proof electrical outlets.
Q. In our OR, no o m person is held responsible for the maintenance and control of electrical equipment. Would it not be a safer practice to have one person responsible for this potential hazard? A. If one person is held responsible for this extremely important task, failures that occur on his days off (vacation and sick days) will probably go unreported. A central alarm built into the electrical system which rings when there is a short circuit in the wiring gives a very good warning. This alarm and light Continued on page 87
85
Continued from page 85
teria. It is good for frequent hand washings because of its bacteriostatic action. This is desirable for suppressing the bacterial flora of the hands which is one of the prime suspects in cross-infections. Everything that can be steam-sterilized should be. Ethylene oxide sterilization is the method of choice for equipment that will not withstand steam sterilization.
combination should be located in a prominent area. When the alarm sounds and the red light appears, an investigation for the potential hazard is made. The faulty appliance is removed from service and repaired immediately. The engineering department should have a thorough preventive maintenance program using a “check-of€‘’ list. A similar program should be carried out for all anesthesia machines and monitoring equip- Q. Should the OR Supervisor be responsible ment by fully qualified technicians. for booking the operative cases or should this be the prerogative of the anesthesiologist? Q. In regard to disposable booties, is it A. The booking of cases for surgery should correct to wear the conductive strip next to the be done by a person specifically trained for bare skin or may it be worn next to the this type of service. The clerical work should stocking? be performed by a secretary or clerk. The A. It is best, if possible, for all personnel operating room supervisor and the anesthesiolassigned to the operating room to have their ogist should combine their information reown conductive shoes. However, if strips are garding the availability of staff with the worn, the important factor is to be certain surgeon who is scheduling cases. The that the stocking is moist with perspiration. schedule of days and rooms for various speThe strip may be worn either outside or inside cialties must also be taken into consideration. the stocking. The conductive indicator should show a positive response to conductivity. Q. When contamination cases are performed under general anesthesia, should the patient Q. One of our anesthesiologists refwes to spend time in the recovery room? clem his equipment following his case. The professional nurses feel that this is his respon- A. Most recovery rooms maintain a cubicle sibility. Who should be responsible for clean- for infected cases. With good individualized patient care which should be tantamount in ing and sterilizing this equipment? A. It is essential that this equipment, which is every recovery room, there should be no in direct contact with the patients, be terminal problem. Every patient having had inhalation ly sterilized after each case. An inventory anesthesia should be kept in the recovery large enough to enable this task to be room until his vital signs become stabilized. performed is required. An anesthesia assistant or aid would be the ideal person to perform Q. We are using wax paper bags in the kick this service. Properly taught and supervised, buckets in our OR. Some of my sta% would such a person could function well in this like to change to plastic liners. Are plastic capacity. This would release the professional bags a hazard? staff from non-professional duties. A. It has been reported that explosions and fires have resulted from the use of nonQ. Is washing the corrugated tubing with conductive plastic bags and liners. Conductive hexachlorophene and water adequate cleaning kick bucket liners are available commercially. between cases? They are economical, moisture-proof, acidA. No! Hexachlorophene does not kill bacContinued on page 91
August 1969
87
Continued from page 87
resistant, light-weight,and non-porous. Because the material is non-porous, there is no leakage of liquids; thus the possibility of cross-infection is minimized. The material provides a low-resistant path to ground, offering complete protection against the hazards of static electricity which may easily be generated when using non-conductive kick bucket liners.
Q. Can linen wrappers be re-used for the wrapping of articles to be sterilized? What is the theory behind it? A. It has been found that if cloth wrappers and linens are not washed after each use, sterilization may be impeded or retarded because the materials do become dehydrated, charred, and stained. However, laundering after each use re-hydrates and prolongs the life of the textiles. (See AORN J o u r d , February, 1969, page 95.) Q. Can disposable packs be re-sterilized if opened and not used? W h t kind of sterilization do you suggest? A. Generally, it is not advisable or economical to re-sterilize unused disposable items. Since many different types of disposable materials are on the market today, it is suggested that you ask the particular manufacturer whether or not re-sterilization is feasible. We put this question to the company which supplies our disposable packs and they state that although these packs can be steamsterilized, there is a possibility of shrinkage and stiffening of the materials. If such items must be re-sterilized, it is recommended that this be done by gas sterilization.
DOCTORS, SURGEONS, NURSES All Hospital Personnel SEE AT A GLANCE Operating room number Patient's name G. room number 0 Type of operation 0 Name of surgeon, anesthetist and and Operating Room Nurses Schedule any number of operating rooms for an number of days. Information recor ed on magneticelementsschedule can be changed in seconds. Names are typed on self-adhesive stickers and adhered to rubber magnets. Magnets are re-used time and time again. Neat, clear, concise. Let us design a system to fit your particular requirements. Write for our FREE 28 page colorfully illustrated catalog and price list. 0
0
J
++
Yes, I answered you last night; No, this morning sir, I say: Colors seen by candlelight Will not look the same by day. Browning
August 1969
91
Q. Who is responsible for establishing safe practices in the operating room? At our hospid, the nurses feel that this responsibility should belong to the OR Supervisor. The Chief of Anesthesiology feels that he should set the policies. A. It is a cooperative effort. The OR Supervisor, with the cooperation of the Anesthesiologist, the Chief of Surgery, the Chief of Engineering and the Administrator, can plan a good safety program for the operating room. A well-trained OR staff can be the best guarantee for a good safety program. This training can be accomplished by demonstrations, lectures, films, and discussions. The OR Supervisor can depend upon the Anesthesiologist for control of anesthetic gases and equipment. She can call upon the engineering department for control of temperature, humidity, electrical systems, and all necessary safety signs. We must also keep in mind that safety measures in the OR are everyone’s responsibility. Q. Our operating room is air-conditioned, so we do not worry too much about the raccumulation of explosive gases. But is there any danger of explosion in an air-conditioned room? A. When we speak of air conditioning an OR,
August 1969
a: we are speaking of many things: 1) Temperature and humidity control. 2) Mechanical ventilation to provide safety and comfort for patients and personnel. 3) Aid in removing odor. 4) Control of air-borne bacteria. The air conditioning reduces the danger of explosion but does not eliminate it. Many factors have to be considered such as: 1) Temperature and humidity. 2) Conductive clothing and footwear. 3) Conductive floors and furniture. 4) Preventive maintenance and handling of electrical equipment. 5 ) Controlled smoking areas. 6) Explosion-proof electrical outlets.
Q. In our OR, no o m person is held responsible for the maintenance and control of electrical equipment. Would it not be a safer practice to have one person responsible for this potential hazard? A. If one person is held responsible for this extremely important task, failures that occur on his days off (vacation and sick days) will probably go unreported. A central alarm built into the electrical system which rings when there is a short circuit in the wiring gives a very good warning. This alarm and light Continued on page 87
85
Continued from page 85
teria. It is good for frequent hand washings because of its bacteriostatic action. This is desirable for suppressing the bacterial flora of the hands which is one of the prime suspects in cross-infections. Everything that can be steam-sterilized should be. Ethylene oxide sterilization is the method of choice for equipment that will not withstand steam sterilization.
combination should be located in a prominent area. When the alarm sounds and the red light appears, an investigation for the potential hazard is made. The faulty appliance is removed from service and repaired immediately. The engineering department should have a thorough preventive maintenance program using a “check-of€‘’ list. A similar program should be carried out for all anesthesia machines and monitoring equip- Q. Should the OR Supervisor be responsible ment by fully qualified technicians. for booking the operative cases or should this be the prerogative of the anesthesiologist? Q. In regard to disposable booties, is it A. The booking of cases for surgery should correct to wear the conductive strip next to the be done by a person specifically trained for bare skin or may it be worn next to the this type of service. The clerical work should stocking? be performed by a secretary or clerk. The A. It is best, if possible, for all personnel operating room supervisor and the anesthesiolassigned to the operating room to have their ogist should combine their information reown conductive shoes. However, if strips are garding the availability of staff with the worn, the important factor is to be certain surgeon who is scheduling cases. The that the stocking is moist with perspiration. schedule of days and rooms for various speThe strip may be worn either outside or inside cialties must also be taken into consideration. the stocking. The conductive indicator should show a positive response to conductivity. Q. When contamination cases are performed under general anesthesia, should the patient Q. One of our anesthesiologists refwes to spend time in the recovery room? clem his equipment following his case. The professional nurses feel that this is his respon- A. Most recovery rooms maintain a cubicle sibility. Who should be responsible for clean- for infected cases. With good individualized patient care which should be tantamount in ing and sterilizing this equipment? A. It is essential that this equipment, which is every recovery room, there should be no in direct contact with the patients, be terminal problem. Every patient having had inhalation ly sterilized after each case. An inventory anesthesia should be kept in the recovery large enough to enable this task to be room until his vital signs become stabilized. performed is required. An anesthesia assistant or aid would be the ideal person to perform Q. We are using wax paper bags in the kick this service. Properly taught and supervised, buckets in our OR. Some of my sta% would such a person could function well in this like to change to plastic liners. Are plastic capacity. This would release the professional bags a hazard? staff from non-professional duties. A. It has been reported that explosions and fires have resulted from the use of nonQ. Is washing the corrugated tubing with conductive plastic bags and liners. Conductive hexachlorophene and water adequate cleaning kick bucket liners are available commercially. between cases? They are economical, moisture-proof, acidA. No! Hexachlorophene does not kill bacContinued on page 91
August 1969
87
Continued from page 87
resistant, light-weight,and non-porous. Because the material is non-porous, there is no leakage of liquids; thus the possibility of cross-infection is minimized. The material provides a low-resistant path to ground, offering complete protection against the hazards of static electricity which may easily be generated when using non-conductive kick bucket liners.
Q. Can linen wrappers be re-used for the wrapping of articles to be sterilized? What is the theory behind it? A. It has been found that if cloth wrappers and linens are not washed after each use, sterilization may be impeded or retarded because the materials do become dehydrated, charred, and stained. However, laundering after each use re-hydrates and prolongs the life of the textiles. (See AORN J o u r d , February, 1969, page 95.) Q. Can disposable packs be re-sterilized if opened and not used? W h t kind of sterilization do you suggest? A. Generally, it is not advisable or economical to re-sterilize unused disposable items. Since many different types of disposable materials are on the market today, it is suggested that you ask the particular manufacturer whether or not re-sterilization is feasible. We put this question to the company which supplies our disposable packs and they state that although these packs can be steamsterilized, there is a possibility of shrinkage and stiffening of the materials. If such items must be re-sterilized, it is recommended that this be done by gas sterilization.
DOCTORS, SURGEONS, NURSES All Hospital Personnel SEE AT A GLANCE Operating room number Patient's name G. room number 0 Type of operation 0 Name of surgeon, anesthetist and and Operating Room Nurses Schedule any number of operating rooms for an number of days. Information recor ed on magneticelementsschedule can be changed in seconds. Names are typed on self-adhesive stickers and adhered to rubber magnets. Magnets are re-used time and time again. Neat, clear, concise. Let us design a system to fit your particular requirements. Write for our FREE 28 page colorfully illustrated catalog and price list. 0
0
J
++
Yes, I answered you last night; No, this morning sir, I say: Colors seen by candlelight Will not look the same by day. Browning
August 1969
91